Endoscopic procedures to treat abnormal pathologies of the alimentary canal and the biliary tree are becoming increasingly common. Endoscopes are often used in these procedures to facilitate access to biliary, hepatic and pancreatic ducts, in addition to the larger alimentary passages. The endoscope itself can only provide access to the general area adjacent to the smaller ducts and navigation of the ducts themselves must be carried out using smaller devices, such as catheters and guide wires in conjunction with fluoroscopy. Targeted delivery of therapeutic agents and surgical procedures within the ducts is typically carried out using catheters.
Methods and devices for using catheters to access the biliary tree are described in U.S. Pat. No. 5,397,302 to Weaver et al., and in U.S. Pat. No. 5,320,602 to Karpiel, the disclosures of which are herein incorporated by reference in their entirety. In a general process, treatment of a patient's biliary tree involves introducing an endoscope in the mouth of a patient, and guiding the distal end of the endoscope through the alimentary tract until a distal opening of the endoscope is adjacent to a targeted area to be treated. Additional devices such as catheters may be introduced through the endoscope to the target area, to perform whatever procedure is required to treat the abnormal pathology. In one procedure, a distal end of the catheter is guided through the orifice of the papilla of vater, which leads into the common bile duct and the pancreatic duct. The catheter is inserted through a lumen of the endoscope, so that it emerges in the ducts at the distal end of the endoscope.
A guide wire may be used in conjunction with the catheter to facilitate accessing the desired location. The guide wire is inserted in an opening at the proximal end of the catheter, and is guided through the catheter until it emerges from the catheter's distal end. The guide wire is then pushed to the target in the common bile duct, and the catheter is advanced over the guide wire until the catheter's distal end reaches the desired target position. A catheter may be selected to deliver contrast media to the target area, for fluoroscopic visualization of anatomical detail within the duct. Different catheters specialized for different functions may be necessary to treat the target area that has been visualized, and a catheter exchange may need to be performed. An exchange involves removing the first catheter and replacing it with a second catheter, without displacing the guide wire during the procedure. If the guide wire is displaced, the guide wire must be redirected through the body to the target area, in a difficult and time consuming procedure.
In a conventional procedure, the physician must grasp the proximal end of the guide wire with one hand to immobilize it, and must perform the catheter exchange with the other hand. This procedure is difficult and often results in displacing the guide wire. In addition, it is often necessary to hold in place more than one guide wire at the same time. Manually holding multiple guide wires is extremely difficult when conventional methods and devices are used, since the surgeon has to manually hold the guide wires in place while at the same time replacing one or more catheters. Additional personnel is often required to carry out the procedure using conventional methods.